Intellectual Disability in Childhood and Adolescence: Social skills and the significance of everyday executive functions for adaptive behaviours and mental health
Doctoral thesis
Permanent lenke
https://hdl.handle.net/11250/3130334Utgivelsesdato
2024Metadata
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- Institutt for psykisk helse [1211]
Sammendrag
The diagnosis of intellectual disability implies that intelligence and adaptive skills are more than two standard deviations below the mean for the age group. Intellectual disability is divided into levels, where mild intellectual disability is the most common form. In mild intellectual disability, the cause of the challenges is often unknown, making it difficult to identify the right help and support to be provided. Research suggests that the relationship between intelligence and adaptive behaviours is complex, thus, there is need to explore if everyday executive functions are a third factor that can be significant for functions and outcomes for this group. This is a factor that is not currently included in the diagnosis but should have a more prominent place in studies of children and young people with intellectual disabilities. In relation to the diagnosis of intellectual disability, intelligence has had a prominent role in the 20th century, but now adaptive behaviours and executive functions receive increased attention as central for individual functioning. There are findings of more mental health problems among people with intellectual disabilities and it is useful to know if this is related to intelligence or other factors. In this thesis, we study the significance of both intelligence and everyday executive functions for adaptive behaviours and symptoms of mental health problems in children and young people with intellectual disability.
Autism and intellectual disability often occur together and there is a need for more information regarding the social challenges related to both diagnoses. This is important information for diagnostic evaluations and for planning of adequate support. Individuals with concurrent intellectual disability and autism have a higher risk of additional challenges, and it is therefore important to recognise autism early, and to offer appropriate help. It is crucial to have assessment tools that can screen for autism among people with intellectual disabilities.
The purpose of this study was to explore the significance of everyday executive functions for adaptive behaviours and symptoms of mental health for 40 children and young people (10 – 17 years) with pre-diagnosed mild intellectual disability. Furthermore, the aim was to study social functioning and screening tools for autism in a group of 78 children and young people (9 – 19 years) where half of the participants already had an autism diagnosis. Data in papers I and II were collected by the candidate from 2018 – 2020. The sample in Paper III is drawn from the BUPgen population.
In summary, these studies showed a significant relationship between everyday executive functions and adaptive skills, but not between intelligence and adaptive skills in this sample with prediagnosed mild intellectual disability. As expected, the prevalence of symptoms of mental health problems was higher in this sample than in the general population. Symptoms of mental health problems were related to everyday executive challenges, but not to intelligence. There were findings of mild to severe levels of social challenges for more than 62% of those with intellectual disabilities without autism measured by the Social Responsiveness Scale, especially in the domain of social cognition. The Social Communication Questionnaire could predict a concurrent autism diagnosis in individuals with intellectual disabilities. This indicates that the SCQ can be a useful tool to identify who has a need for further evaluation for autism in this population.
For some time, it has been assumed that factors other than intelligence and adaptive behaviours can be of significance for the lives of individuals with intellectual disabilities. Our results indicate that everyday executive functions can be an important source of information regarding what help and support to offer. Additionally, our findings suggest that supporting adaptive behaviours and everyday executive functions can have a potential related to preventing mental health issues in this group. It has been proposed that executive functions could be a mediator between activation and cognitive demands. This should be further researched in this population. By working both from a societal and an individual perspective to minimize the gap between environmental demands and individual competence, an integrated approach to intellectual disability can be maintained and potentially lead to better mental health in this population.